The premenstrual syndrome: amelioration of symptoms after hysterectomy

What is the role of the uterus in the aetiology of the premenstrual syndrome (PMS)? Twelve women kept a daily symptom record before and after hysterectomy. Psychological and physical symptom patterns were analysed by Fourier analysis and the response to hysterectomy by maximum likelihood ANOVA. Hysterectomy was associated with a 66% reduction in mean premenstrual tension (PMT) severity for both psychological and physical symptoms (p less than 0.005). The milder symptoms appeared unrelated to post-operative changes in health or ovarian function. Seven women experienced mood-related PMT in every pre-hysterectomy cycle; the persistence of unfailing mood-related PMT in one of these women after hysterectomy suggests that her symptoms were hormonally controlled and the loss of regular PMT in the other six women suggests that a uterine factor, or psychological factors associated with the menstrual cycle were implicated. We conclude that a uterus is not essential for the expression of PMT, but that its removal often results in the amelioration of symptoms.